CHAP, ix.] VELLA'S DOUBLE INTESTINAL FISTULA. 407 



importance to the physiologist and the pharmacologist, the Author 

 thinks it useful to describe the operation in detail and to mention 

 modifications which experience has shewn to be necessary and to 

 lead to almost invariable success. 



The abdominal wall of a fasting dog (preferably a bitch) is shaved 

 and thoroughly disinfected by repeated washing with soap and water 

 and then scrubbing with a 1 per mille solution of corrosive sublimate. 

 The instruments to be employed are sterilised and the operator and 

 assistants observe the strictest rules of antiseptic surgery. The 

 animal having been deeply anaesthetised, by means of morphia and 

 chloroform, an. incision, about 5 centimetres long, is made through 

 the abdominal wall, in the linea alba. A thoroughly sterilised piece 

 of lint, or linen, is then wrung out of a sterilised solution containing 

 O'G per cent, of NaCl and 5 per cent, of carbolic acid, at a tempera- 

 ture of 40 C., and this is placed over the abdominal wall of the dog. 

 The operator then proceeds to select the part of the intestine where 

 the fistula is to be established. Drawing out a loop including the 

 selected portion, he protects it from atmospheric impurities and, so 

 far as possible, prevents too great a lowering of temperature, by 

 covering it with cotton or linen cloths wrung out of the warm 

 antiseptic solution. The portion of intestine to be isolated may 

 be between 200 and 500 millimetres in length, though the difficulties 

 are much greater in the latter than the former case. The first stage 

 of the operation is performed as described previously (Thiry's fistula). 

 The second stage is, however, different and presents greater diffi- 

 culties. Instead of closing, by sutures, one end of the isolated 

 portion of intestine, and establishing a cul de sac, its two ends are 

 separately sewn to the incision in the muscular wall of the abdomen, 

 one in front of the other. Two openings are thus established, one in 

 front of the other, of which one communicates with the proximal and 

 the other with the distal portion of the isolated intestinal tube. 



The operation of fixing the ends of the intestine to the incision 

 in the abdominal wall is facilitated by previously passing long 

 ligatures through either end. These serve to pull upon, and to hold, 

 the ends in any required position and to prevent their slipping back 

 into the abdominal cavity during the operation. It is highly advi- 

 sable, also, before proceeding to fix the two ends, i.e. as the very first 

 step in the second stage of the operation, to make a longitudinal 

 incision about two centimetres in length through the walls of each 

 end of the gut and then to pass sutures through the peritoneal coat 

 a little distance on either side of this incision. By tying these, the 

 lumen of the gut is narrowed at both ends, the object being to 

 prevent prolapsus of the intestinal mucous membrane, an event 

 which otherwise invariably occurs both in the case of Thiry's and 

 Vella's fistulas, at periods varying between two or three months from 

 the operation 1 . 



1 At the present time the Author is experimenting on a dog in which a Vella's 

 fistula was established on Jan. 5, 1893, the precaution of narrowing the gut at its 



